This document summarizes the results of the 2013-2014 dental health screening program in Saskatoon Health Region. It found that dental decay was more prevalent in Grade 1 students compared to Grade 7 students. The burden of poor oral health was highest among Aboriginal, new immigrant, and low-income communities. While most communities received fluoridated water, the levels were often below the recommended amount. Overall, children's oral health in the region has declined over the past two decades and guidelines for improving oral health were not met for most grades and ages. Recommendations include expanding dental coverage and public health clinics.

1. Dental Health Screening Program
Report
2013-2014
Saskatoon Health Region
(SHR)
• Muddassir Razi Siddiqui – MPH student, University of Saskatchewan.

2. Introduction:
1993 – Saskatchewan Dental Health Education mandated a
dental screening component to be repeated at 5 year intervals.
Purpose – To assess the oral health of children in SHR and
gauge the effectiveness of preventive programs and policies.
Significance:
oOral health is a fundamental component of general health .
oDental diseases are preventable.
2013-2014 – It marks two decades of dental surveillance.

3. Methods:
Data Collection:
oParticipation: 148 schools in Saskatoon Health Region → Grade 1 &
7.
oPerformed by: licensed Saskatchewan Dental Therapists → aided by
mouth mirror, LED flashlight and tongue depressor.
oData recordings: History, Visual Examination.
Data analysis:
oMicrosoft Access database → Microsoft Excel & SPSS.
oData filtered, cleaned and analyzed.
oDescriptive statistics → summarize data.
oInferential Statistics →
 Comparative Analysis.
 Chi-Square, Fischer’s Exact & Independent two
sample t-test.

4. Results:
 Participation:
TOTAL
ENROLMENTS
TOTAL
SCREENED
TOTAL
ABSENT
TOTAL
REFUSED
7508 6611(88.05%) 551(7.34%) 346 (4.61%)
Mean Age
 Age:
Grade 1 6.60 years (79.25 months)
Grade7 12.62 years (151.46 months)
Screening by Location
Saskatoon Warman Martensville Humboldt
All Other
Locations
80%
70%
60%
50%
40%
30%
20%
10%
0%
 Location:
STUDENTS SCREENED 70.47% 3.81% 3.33% 2.34% 20.05%

5. ORAL HEALTH ISSUES
2013-2014
Grade 1 vs. Grade 7
CALCULUS STAINING GINGIVITIS
MALOCCLUSI
ON
50%
40%
30%
20%
10%
0%
GRADE 1 2.47% 4.73% 0.22% 22.68%
GRADE 7 5.85% 6.12% 11.17% 43.66%
0.88% 1.10%
98.02%
Early Childhood Tooth Decay
ECTD
S-ECTD
NON-ECTD
Results:
 Oral Health Issues:
 Early Childhood Tooth Decay

6. Dental Health Status
3.80%
Grade 7
3.83%
36.26% 56.10%
NDE
CCC
PCC
NEC
11.11%
Dental Health Status
51.51%
7.07%
33.61%
Grade 1 & 7
7.82%
NDE
CCC
PCC
NEC
Results: Dental Health Status:
• NDE = No Decay Experience
indicates that no decay, fillings or extractions are
evident.
• CCC = Complete Caries Care
indicates that all decayed teeth appear to have
been treated.
• PCC = Partial Caries Care
indicates that some teeth have been treated, but
decay is still evident.
• NEC = No Evidence of Care/Neglect
indicates that there is decay but no evidence of
past or present dental treatment.
Grade 1:
Grade 7: Grade 1 & 7:
47.74%
31.43%
9.71%
Dental Health Status
Grade 1
NDE
CCC
PCC
NEC

7. 0.81% 6.15%
93.04%
Priority Scores
Grade 7
Priority Score 1
Priority Score 2
Priority Score 3
1.54%
18.11%
80.35%
Priority Scores
Grade 1
Priority Score 1
Priority Score 2
Priority Score 3
1.21%
12.73%
86.05%
Priority Scores
Grade 1 & 7
Priority Score 1
Priority Score 2
Priority Score 3
Results: Dental Health Needs – Priority Scores:
 Priority 1 = Urgent (pain or infection)
requiring immediate treatment.
 Priority 2 = Treatment required as soon
as possible.
 Priority 3 = No immediate treatment
required
Grade 1:
Grade 7: Grade 1 & 7:
Unmet dental health
needs = 19.65%
Unmet dental health
needs = 6.96%

8. Results: “deft’’ & “DMFT” scores
 “ deft” score: decayed, extracted, filled primary teeth.
 Prevalence of dental decay in deciduous teeth.
 “ DMFT” score: Decayed, Missing Filled permanent teeth.
 Prevalence of dental decay in permanent teeth.
 The overall deft & DMFT scores ≥ 1:
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
deft' deft' DMFT' DMFT'
GRADE 1 GRADE 7 GRADE 1 GRADE 7

9. Results: “deft’’ & “DMFT” scores
 The average deft + DMFT score  Grade 1 vs Grade 7:
Average "deft" + "DMFT"
Grade 1 vs Grade 7
Grade 1 Grade 7
3
2.5
2
1.5
1
0.5
0
Average deft + DMFT 2.79 1.25

10. Results: Historical Comparison
Average deft/DMFT
Comparison Screening Year
1993-
1994
Grade 1
1998-
1999
2003-
2004
2008-
2009
2013-
2014
3.5
3
2.5
2
1.5
1
0.5
0
Average deft/DMFT 3.13 2.45 2.15 2.36 2.79
% with Cavities
Comparison by Screening Year
1993-
1994
Grade 1
1998-
1999
2003-
2004
2008-
2009
2013-
2014
25%
20%
15%
10%
5%
0%
% with Cavities 17.30% 20.50% 16.60% 19.20% 20.92%
No Evidence of Dental Care
Comparison by Screening Year
1993-
1994
1998-
1999
2003-
2004
2008-
2009
2013-
2014
12%
10%
8%
6%
4%
2%
No Evidence of
Dental Care
8.20% 10.00% 10.30% 9.30% 11.11%
0%
Grade 1
Comparison by Screening Year
1993-
1994
Cavity Free
Grade 1
1998-
1999
2003-
2004
2008-
2009
2013-
2014
56%
54%
52%
50%
48%
46%
44%
42%
Cavity free 51.60% 53.80% 53.90% 50.80% 47.28%
Grade 1

11. Results: Historical Comparison
Average deft/DMFT
Comparison by Screening Year
Grade 7
2008-2009 2013-2014
1.4
1.2
1
0.8
0.6
0.4
0.2
0
Average deft/DMFT 0.85 1.25
% with Cavities
Comparison by Screening Year
Grade 7
2008-2009 2013-2014
20%
15%
10%
5%
0%
% with Cavities 6.40% 16.85%
2008-2009 2013-2014
3.90%
3.80%
3.70%
3.60%
3.50%
No Evidence of
Dental Care
3.60% 3.83%
3.40%
No Evidence of Care
Comparison by Screening year
Grade 7
Cavity free
Comparison by Screening Year
Grade 7
2008-2009 2013-2014
70%
65%
60%
55%
50%
Cavity free 66.60% 55.57%
Grade 7

12. Results: Canadian Oral Health Framework 2013-2018
COHF 2013-2018
Appendix 1: Improve Oral Health of Children
Grade-1
Indicators 2013-2014 results
# Indicator 2013-2014 Results
1.a deft +DMFT of <2.5 2.79
1.b ≥ 55% have deft +DMFT=0 47.28%
1.c <15% have d+D>0 20.92%
Grade-7
Indicators 2013-2014 results
# Indicator 2013-2014 Results
1.d DMFT of <1.0 0.93
1.e >70% have DMFT=0 63.90%

13. Results: Canadian Oral Health Framework 2013-2018
COHF 2013-2018
Appendix 2: Improve Oral Health of Aboriginal People
Grade 1
2013-2014 results
Indicators
# Indicator 2013-2014 Result
2.c
> 15%of 6 y.o. FN/I have dmft +DMFT=0 of 6 year-old
First Nations and Inuit children have not had tooth decay
19.79%
Grade-7
2013-2014 results
Indicators
# Indicator 2013-2014 Result
2.d > 20% of 12 y.o. FN/I have DMFT=0 39.81%
Provision of preventive dental services
2013-2014 results
Indicators
# Indicator 2013-Result
2.b
> 50% of FN/I schools provide school-based
preventive dental services 100%

14. Results: “Comparative Analysis”
Location of School → Urban vs. Rural
Neighborhood Income Status → Low Income Measure (LIM)
neighborhoods vs. Non-LIM neighborhoods
Immigration Status → New Immigrants vs. Settled residents
Aboriginal Status → Aboriginal vs. Non-Aboriginal
Dental Visits → No History of Dental Office Visit vs. History of Dental
Office Visit
Dental Insurance → Without Dental Coverage vs. With Dental Coverage
 Community Water Fluoridation → Fluoridated vs. Non-Fluoridated
communities

15. Results: “Community Water Fluoridation”
Community Water Supply
Fluoridated vs. Non-Fluoridated communities
Fluoridated Non-Fluoridated p-value
DMFT Score(a) 0.44 0.48 0.420
deft Score(a) 1.65 1.75 0.446
Caries Free - Permanent Dentition(b) 5694 (97.02%) 706 (95.15%) 0.060
Caries Free - Primary Dentition(b) 5137 (87.53%) 654 (88.14%) 0.060
Childhood Tooth
Decay(b)
ECTD 155 (2.64%) 9 (1.21%) 0.018
S-ECTD 58 (0.99%) 6 (0.81%) 0.638
Oral Health Status(b)
NDE 3036 (51.73%) 368 (49.60%) 0.273
CCC 1968 (33.53%) 255 (34.37%) 0.650
NEC 456 (7.77%) 61 (8.22%) 0.666
Priority Scores(b)
1 63 (1.07%) 17 (2.29%) 0.004
2 760 (12.95%) 82 (11.05%) 0.144
3 5046 (85.98%) 643 (86.66%) 0.614
Existing Pain(b) Yes 71 (1.21%) 17 (2.29%) 0.015
 Out of 13 oral health indicators  the differences in 10 were statistically insignificant

16. Results: “Community Water Fluoridation”
Epidemiological Association:
ODDS RATIO Dental Decay Decay free Total
Non-Fluoridated 378 364 742
Fluoridated 2861 3008 5869
Total 3239 3372 6611
Odds Ratio: 1.1 ( p-value = 0.29)
Fluoridated vs. Non-Fluoridated (1)
Caries Free -
Perm.
Community Water Supply
Caries Free - Prim. NDE CCC P.S 3
120%
100%
80%
60%
40%
20%
0%
Fluoridated 97.02% 87.53% 51.73% 33.53% 85.98%
Non-Fluoridated 95.15% 88.14% 49.60% 34.37% 86.66%

17. Results: “Community Water Fluoridation”
Community Water Fluoridation
(CWF) in SHR 25 communities.
Water Fluoridated Communities
Aberdeen *
Allan*
Annaheim**
St. Isidore Bellevue**
Bradwell*
Bruno**
Clavet*
Cudworth**
Domremy**
Dalmeny*
Elstow*
Dundurn*
Hague*
Hanley*
Hepburn*
Humboldt**
Lake Lenore**
Martensville*
Muenster**
Osler*
Quill Lake
Saskatoon
Wadena
Wakaw
Warman *

18. Results: “Community Water Fluoridation”
Water Fluoride Levels in SHR:
."For a dental benefit the fluoride level needs to be adjusted to 0.7 mg/L“ and as advocated by
Health Canada, the level should be maintained to protect the teeth from dental decay”.
Saskatoon Water Plant - Annual Fluoride Level
(mg/L)
2008 2009 2010 2011 2012 2013
0.48 0.52 0.63 0.25 0.16 0.61
Wakaw Water Plant- Annual Fluoride
Level (mg/L)
2008 2009 2010 2011 2012 2013
0.65 0.57 0.60 0.42 0.48 0.61
Wadena Water Plant - Annual Fluoride
Level (mg/L)
2008 2009 2010 2011 2012 2013 2014
0.64 0.54 0.51 0.54 0.47 0.58 0.34
Quill Lake Water Plant - Annual Fluoride Level
(mg/L)
2010 2011 2012 2013 2014
0.78 0.79 0.73 0.80 0.80

19. Conclusions:
•Dental decay more prevalent in Grade 1 than Grade 7
–→ Average deft+ DMFT → Grade 1 = 2.79 & Grade 7 = 1.25.
•Burden of poor oral health
–→ Aboriginals, new immigrants and Low income neighborhoods.
•Change of trend
–→ Rural schools scored better.
•No significant impact of water fluoridation on dental health.
oHighlights the issue of optimal water fluoridation at 0.7 mg/l → necessary for
dental benefits.
oFluoridated communities → inadequate water fluoridation → no dental benefits.
oNone of the communities receive fluoridation at the optimum level except Quill
Lake.
•Oral health of children in SHR
–It has declined over the last two decades.
•Except for one , none of the COHF guidelines were met for Grade 1/age 6
and Grade 7/age 12.

20. Recommendations:
Support universal dental health coverage.
Targeted dental insurance/coverage for vulnerable populations.
Expansion of dental public health clinics in SHR.
Healthy public policy to support adequate community water fluoridation at
the optimum level of 0.7mg/L.
Enhance community engagement in oral health promotional activities
oOral health counselling and education programs to engage parents and extended families.
oUnderstanding the importance of cultural diversity in health promotion activities especially
in SHR.
Develop programs to provide preventive dental health services to
pre-schoolers. (< 6 years of age)
Continue with :
oOngoing oral health surveillance,
oPreventive oral health services to high risk schools,
oFluoride varnish and sealant programs.

21. Acknowledgments:
 Ms. Leslie Topola – Manager, Population and Public Health, SHR.
 The Oral Health Program – Population and Public Health , SHR.
 Dr. Michael Szafron – Biostatistician/ Practicum Coordinator, University
of Saskatchewan.
 Dr. John Moraros – Academic Advisor, University of Saskatchewan.

22. References:
•Saskatoon Health Region. Dental Health Screening Program Report Grade One and Grade Seven 2008-2009.
Saskatoon Health Region. ,2010 Reducing Dental Diseases : Federal, Provincial and Territorial Framework for Action
to Improve Oral Health[internet] 2012[28 August 2014].Available from :
http://www.caphd.ca/sites/default/files/FrameworkOctober15FINALEnglish.pdf
•Water Fluoridation in Canada: Past and Present. JCDA [Internet]. 2009 [28 August 2014];75(6):451-454. Available from:
http://www.cda-adc.ca/jcda/vol-75/issue-6/451.pdf
•Dental Health Promotion Working Group of Saskatchewan. Saskatchewan Community Fluoride Data 2010.
[internet] 2011 p. 1-55.[28 August 2014].Available from : http://www.health.gov.sk.ca/SK-community-fluoride-data-
2010
•Hansen L, Mclean L. DENTAL HEALTH SCREENING PROGRAM 2003 - 2004. Saskatoon: Saskatoon Health Region -
Public Health Services; [internet]2006 P. 1-48. [28 August 2014].Available from :
https://www.saskatoonhealthregion.ca/locations_services/Services/Oral-
Health/Documents/SHRDentalScreeningProgramReport2003-2004.pdf
•Findings and Recommendations of the Fluoride Expert Final (January 2007). Data retrieved from the
website:http://www.hc-sc.gc.ca/ewh-semt/pubs/water-eau/2008-fluoride-fluorure/index-eng.php.
•City of Saskatoon. Drinking Water Quality and Compliance :City of Saskatoon -for Year 2012.Annual Notice to
Consumer [Internet]. 2014 [24 August 2014]. Available from:
http://www.saskatoon.ca/DEPARTMENTS/Utility%20Services/Water%20and%20Wastewater%20Treatment/Docum
ents/Drinking%20Water%20Quality%20and%20Compliance%20Report%202012.pdf
•Sheiham A. Oral health, general health and quality of life [Internet]. World Health Organization (WHO). 2005 [24
August 2014]. Available from: http://www.who.int/bulletin/volumes/83/9/editorial30905html/en/-WHO bulletin
•Low income measures [Internet]. 2009 [24 August 2014]. Available from:
http://www.statcan.gc.ca/pub/75f0002m/2009002/s3-eng.htm
•Health Canada. First Nations and Inuit Health - Main Page - Health Canada [Internet]. 2014 [24 August 2014].
Available from: http://www.hc-sc.gc.ca/fniah-spnia/index-eng.php
•Government of Saskatchewan. Family Health Benefits [Internet]. 2014 [25 August 2014]. Available from:
http://www.health.gov.sk.ca/family-health-benefits/

23. Thank you

24. Questions ?